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A DAY IN THE LIFE OF ROLF KLEMM
A Day in the Life
of Rolf Klemm
“Delivering what the science has shown to work”
A specialist in researching and implementing
nutrition programs, Rolf Klemm is Vice President of
Nutrition, Helen Keller International (HKI) and also
Senior Associate in the Program in Human Nutrition,
Department of International Health, Johns Hopkins
Bloomberg School of Public Health. He speaks
with Sight and Life about his passion for effective
implementation of nutrition programs.
Sight and Life (S&L): Rolf, congratulations on your recent
appointment as Vice President for Nutrition with Helen Keller
International. At the same time, you hold a faculty appointment
at Johns Hopkins Bloomberg School of Public Health. How do you
manage the demands of these two roles?
Rolf Klemm (RK): Keeping one foot in academia while providing
technical leadership to HKI’s nutrition programs has been a challenge. I love teaching, mentoring and research. But I wanted to
apply these passions in an organization committed to bridging
the “know–do” gap – a gap that exists because of the lack of evidence about “how” to deliver evidence-based nutrition interventions at scale. I’m passionate about linking research methods
and academic rigor with the practical and applied demands of
field programs. My work with HKI gives me an opportunity to
do just that. But you asked how I manage the demands of both
roles. It’s a struggle to find the right balance. My learning curve
at HKI is steep because of the organization’s large and diverse
nutrition portfolio, different program contexts, multiple country
teams, varying levels of capacity, and different funder demands.
And it’s hard to let go of my teaching, research and mentoring
responsibilities at Hopkins.
S&L: In terms of your working week, how do you divide up your
time between the two commitments?
RK: Officially, 80 per cent of my time is spent on HKI and 20 percent on Hopkins – although in reality the percentages often add
up to much more than a hundred! I’m trying to find synergies
to make my dual role more manageable. I’m hoping to engage
students from Hopkins and elsewhere as interns to assist me.
On a day-to-day basis, when not traveling, I spend 1–2 days a
week working out of my Hopkins office in Baltimore and 3–4
days a week working out of HKI’s sub-office in Washington, DC.
My commute to Hopkins is 25 minutes by bike, but it’s about
2 hours to HKI’s DC office. Fortunately, one of those hours is
spent on a train, where I can get some work done.
S&L: Do you feel that your colleagues at both institutions
understand your desire to embrace both ends of the intellectual
spectrum, from scientific research to program implementation?
RK: I think so. HKI hired me to strengthen its evidence-based
programming, create minimum program standards, and provide access to, and guidance on, state-of-the-art nutrition
knowledge and methods. HKI has existing research and technical expertise, but I hope I can help strengthen this and can
assist HKI in continuing to generate high-level research on
delivering effective nutrition and agricultural interventions.
My Hopkins colleagues support my engagement in program
implementation because it offers real-world contexts for studying and understanding barriers and facilitators for intervention scale-up, brings real-life experiences into the classroom,
and offers field placement opportunities for students interested in learning about program implementation. So I think
there’s an appreciation on both sides for my range of interests.
S&L: You’re currently running a number of implementation
programs in widely differing regions of the world, from Nepal to
Malawi. Do all these programs share certain key characteristics,
or are they each unique in their own way?
SIGHT AND L IFE | VOL. 28(2) | 2014
“More and more academics are getting
interested in implementation science” Rolf Klemm at HKI's New York Office.
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A DAY IN THE LIFE OF ROLF KLEMM
your results are reliable and transparent? Or, to put it another way,
what do you mean when you say in your Johns Hopkins profile that
“It involves a village or more to conduct this research?”
JiVitA study training, Gaibanda, Bangladesh.
RK: The programs are each unique, but they also share certain
characteristics. Program differences arise within each country
and project because of unique social and cultural contexts, leadership and policy environments, program objectives and designs,
service delivery infrastructure, capacities, and experience levels.
Program similarities emanate from the use of common assessment, design and implementation processes. For example, HKI’s
programs are informed by a thorough problem assessment – the
causes, context, stakeholder perspectives, implementation barriers and lessons learned from previous failures. This is a critical
first step, no matter where a program may be located.
HKI programs also use a program impact pathway analysis
process to determine the kinds of inputs, activities and outputs
needed to achieve program outcomes. This has led to the intentional integration of gender equity, social inclusion and behavior
change communication strategies within most of HKI’s agriculture and nutrition programs. It has also challenged HKI and its
partners to think “outside the box” and create innovative ways
to deliver nutrition and agricultural services. Traditionally, nutrition service delivery has relied exclusively on an over-burdened
health system. But health workers have many other programs to
deliver besides nutrition.
In summary, the principles and processes used by HKI for
programs are similar, even though the contexts, scopes and nature of programs may differ across countries.
“Health workers have
many other programs to deliver
besides nutrition”
S&L: Evidence-based policy-making calls for accurate evaluation
of field trials. What is the relationship between the design and the
evaluation of programs in the field, and how can you ensure that
RK: “It involves a village or more to conduct this research” refers
to the extraordinary effort and numbers of individuals needed
to conduct high-quality, large-scale, community-based studies.
Our Hopkins nutrition team has conducted studies requiring
sample sizes of tens of thousands of pregnant women and liveborn babies. Setting up a high-quality research infrastructure in
a rural area in countries such as Bangladesh, Nepal or Zambia,
where such infrastructures are absent, involves a major effort.
Before the first datum is collected, tens or hundreds of field
workers need to be hired, thousands of households need to be
enumerated, mapped, and addressed, hundreds of staff need to
be trained and standardized on data collection and measurement procedures, multiple field offices need to be set up, and
quality control, administrative, financial, logistic and data management systems need to be established. Taking on this kind of
effort certainly requires more than a village.
S&L: What then is the relationship between a good and accurate
piece of research in the field and the development of policies and
programs that will meet the needs of the wider world? How do you
get the thinkers, the movers & shakers, and the budget-holders to
take notice of your findings?
RK: Translating evidence into policies and programs is something of a messy business. The good news is that evidence
can indeed have a powerful influence on policy- and programmaking. The bad news, however, is that it sometimes gets submerged by a host of other factors, including special interests
and politics.
The first step is achieving scientific consensus by examining the “body of evidence” on a health or nutrition intervention
and weighing the study designs, study populations, and contexts, because “One trial doth not a policy make” – nor should
it. The World Health Organization uses a systematic process for
evidence-grading and forming policy guidelines, but this can be
a lengthy and cumbersome process. Also, global guidelines may
not be applicable in every setting due to contextual differences.
Once guidelines are issued, getting in-country “buy-in” and policy and program translation requires many other processes such
as advocacy among national scientists, policy-makers and other
key stakeholders. It involves working with in-country partners
and institutions to determine feasible and affordable delivery
mechanisms appropriate for the local context. And it often involves testing the feasibility of that new intervention in the actual program delivery setting. Rarely do procedures used during
the efficacy studies conducted in highly controlled settings map
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A DAY IN THE LIFE OF ROLF KLEMM
Rolf gives a talk at Acting on the Call – ending preventable child and maternal deaths, at USAID Ronald Reagan Building, June 2014.
well to program conditions in less controlled and messier realworld conditions.
For example, our Hopkins team conducted a study on a
promising new intervention that involves supplementing infants shortly after birth with a single, large oral dose of vitamin A (50,000 IU). This intervention was tested in two field
trials in Southern Asia with known high levels of maternal vitamin A deficiency, and found significant reductions of ≥ 15% in
infant mortality in the first six months of life. Translating these
findings into feasible programs in settings where often > 80%
of infants are born at home required engaging the Bangladesh
Ministry of Health and Family Welfare in testing the feasibility of innovative delivery approaches at an expandable scale to
identify potential barriers and bottlenecks, community receptivity and potential reach.
In academia, success is largely measured by getting your
study findings published in scientific journals. But in the program world, rarely do policy-makers have access to, or the time
or background to read, scientific journals. So scientific findings
and their implications need to be “brought to life” for policymakers through meetings, policy briefs and other advocacy and
communication channels.
“The support of local leadership
is essential”
S&L: What is the biggest challenge currently facing the global
nutrition community, in your view?
RK: I see three grand challenges. First, is addressing girls’ and
women’s nutrition both to optimize their own health and to
ensure they enter and complete pregnancy and lactation well
nourished. The global nutrition community must create linkages
across sectors, especially family planning and education, to
delay early adolescent marriage and pregnancy, because these
have a direct bearing on the health of girls and their offspring.
We also need to define, advocate for, and hold ourselves accountable for creating and ensuring the delivery of an integrated
package of evidence-based, pre- and postnatal services aimed
at improving the health of women during and after pregnancy. A
healthier woman increases the chances of a healthier newborn,
infant and child.
The second grand challenge is creating an evidence base for
nutrition-sensitive interventions. Investment in rigorous research
is needed to answer questions such as: “Can agriculture or water,
sanitation and/or hygiene interventions accelerate improvement
in child nutrition status?” and, “If so, what kinds of intervention
have the greatest impact, and in which populations?” Also, “What
are the impact pathways, and which ones are more important in
which contexts?”; “How can they be positively influenced?” and
finally, “What is the cost-effectiveness of these interventions?”
The third “grand challenge” is building in-country capacity
to deliver proven nutrition interventions at scale to vulnerable
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A DAY IN THE LIFE OF ROLF KLEMM
and to be humbled by the dignity with which many poor people
live and cope in spite of extreme conditions.
S&L: What are the aspects of your career that are most
precious to you?
Meeting with New Era data collectors in Jumla,
Nepal (August 2013).
populations with high quality and fidelity. This requires providing technical, managerial and funding support to build incountry capacity, helping countries move from “donorship” to
“ownership”, and investing in ways to improve the delivery of
nutrition services and products. This will involve technical and
other investments in institutions, processes and systems for preservice and in-service training, logistics and supplies, behavior
change communications, gender equity and social inclusion,
performance monitoring, and evaluation. This challenge will
also need to find ways of establishing smart partnerships with
the private sector.
S&L: What attracted you to a career in nutrition
in the first place, Rolf?
RK: Public health nutrition found me rather than the other way
around. As a boy, I was fascinated by the life and work of Albert
Schweitzer – a medical missionary who served in Africa – and his
life influenced me to take pre-medical courses in college. After
college, I discovered public health nutrition working as a Peace
Corps Volunteer in rural northern Philippines, working side by
side with clinic-based and volunteer health workers, weighing
infants and young children, organizing health classes, and seeing first-hand the tragic consequences of inadequate nutrition
and disease in a poor population. This experience made me
realize that basic public health measures in health, sanitation
and nutrition could benefit far more individuals in developing
countries than high-tech hospital-based medicine. As a young
idealist, public health nutrition also appealed to my sense of social justice and my desire to work for the interests of people living in deprived circumstances. On a selfish note, this career has
given me opportunities I could not have dreamed of – to travel
to remote corners of the world, to work and learn from extraordinary scientists, field workers, community volunteers and other
professionals across many disciplines and cultural backgrounds,
RK: First, it is working on challenging and important problems
with dedicated, bright and altruistic people in the public health
field. I owe a great debt of gratitude to my mentors and colleagues, from my Peace Corps days in the Philippines through
my research life at Hopkins and to my re-immersion now in
programs at HKI. I’ve also been inspired by the experience of
working in countries where opportunities are limited, yet people
do everything they can to “make the impossible possible.” I’ve
worked alongside some very bright people who could probably
enjoy a very comfortable life if they chose to work elsewhere, in
a different field, and I deeply admire their energy and commitment. I also really value the companionship and inspiration of
my colleagues at Johns Hopkins. Their rigor and dedication are
astonishing. One other precious aspect of my career was finishing my doctoral degree at Hopkins at the “ripe old age” of 45,
with a wife and three daughters in tow. I owe many thanks to
my wife and daughters for their support and sacrifice during my
studies. And, while I didn’t become a “real” (i.e., medical) doctor – as my dad would have liked – I think he beamed a heavenly
smile when I graduated. Neither he nor my mother, who immigrated into the US from Germany, had a chance to go to college
due to World War II.
“The rigor and dedication of
my colleagues at Johns Hopkins
are astonishing”
S&L: You clearly love what you do, and you speak about your
work with great passion. What are the key qualities of a successful
implementation scientist, in your view?
RK: That’s a good question! First, there’s no substitute for field
work. You need to go to where the problems are. You need to
listen to women, elders, formal and informal community leaders, health workers and village volunteers to understand their
needs and aspirations and to hear their perspectives on service
delivery barriers and opportunities, and to know the context
in which policies and programs are made and implemented.
Second, you need expertise in research design and methods to
help you choose the best designs and methods to answer specific implementation questions. And finally, you need to build
constructive relationships and partnerships that bring together
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researchers and implementation organizations to help translate science into doable programs, measure the program performance and outcomes, and share lessons learned from failure
and success.
S&L: You’ve mentioned how you value the team at Johns Hopkins
and also how important it is to understand the situation of people
at the local level. What’s the secret of ensuring good teamwork,
in your opinion?
RK: Of course, successful teamwork requires finding the right
people with the right skills and expertise to solve a problem. But
this is not enough. Teamwork requires helping team members
buy into a larger goal or vision and to see clearly how each team
member plays a critical part in achieving the larger goal. In a
research study, this means communicating why answering a specific research question might have profound effects on people’s
lives. People need to feel inspired, appreciated, supported and
recognized for their contribution to the larger goal. They also
need supportive feedback so they know if they are on the right
track. Public health research and implementation is a “people”
business, and calls for people who are not only technically competent, but also flexible, creative and compassionate.
“People need to feel
inspired, appreciated
and supported”
S&L: What do you find most rewarding about your activity
as a nutritionist?
RK: In this stage of my career one my greatest rewards comes
from mentoring the next generation of nutrition leaders through
Rolf with Dr S Kaushik, Micronutrient Initiative Asia Regional
Manager for Monitoring and Evaluation, at the 2014 Micronutrient
Forum Global Conference in Addis Ababa, Ethiopia.
A DAY IN THE LIFE OF ROLF KLEMM
teaching, coaching and advising students on the Hopkins and
HKI country teams. I also still treasure field visits to assess program implementation and listen and learn from program beneficiaries, implementers and managers about how to improve the
delivery of nutrition and health services.
S&L: If you could change the nutrition community in one way,
what would you do?
RK: I’d like to see us listening more to the countries we’re trying
to serve and to be more responsive to their needs – not all of
which are technical.
S&L: Do you have a hero, a major influence, or a favorite saying?
RK: I have many heroes. Albert Schweitzer was a boyhood hero
who inspired my interest in health and service in developing
countries. Helen Keller’s life has inspired me to take risks, be
courageous and stay optimistic in spite of daunting challenges.
Her life, in many ways, is a testament to “making the impossible possible”, and mirrors challenges faced in addressing global
malnutrition. Also, mentors like Al Sommer and Keith West have
influenced me to go where the problems are, get out in the field,
collect data that’s believable, use data to influence policy and
take the long view. I’m also inspired by ordinary people I meet
through my research and projects, especially those who live dignified lives in the face of extraordinary poverty, lack of opportunity and injustice. They are heroes in their own right.
S&L: : If you had not become a nutritionist,
what course do you think your life might have taken?
RK: Whatever other course my life might have taken, I’m sure
it would have involved scientific inquiry, teaching, coaching,
mentoring, and, maybe, music. I love music, and enjoy playing
my alto saxophone or improvising on the piano. The skill level
needed to play or compose professionally was, and is, well beyond my reach, but it’s fun, nonetheless, to fantasize about a
life making and playing music. Perhaps I’ll return to playing jazz
more seriously when I retire. In the meantime, when I travel
– and I travel a great deal in connection with my work – I sometimes carry a xaphoon. This is a chromatic, single-reed woodwind instrument made of bamboo which is a lot more portable
than a saxophone but much more difficult to play, especially
with my stubby fingers!
S&L: What would your advice be to readers of this magazine
who wish to get involved in implementation science in the field
of nutrition?
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RK: There’s no substitute for getting to the field – by which I
don’t mean sitting in an office in a capital or a provincial city
abroad. Try getting an internship or a job with a non-governmental organization that is working alongside government and other
local counterparts to deliver evidence-based interventions. Seek
out opinions from community members and service providers
about the quality and perceived value of services, barriers to
implementation and ways to improve services. Learn a mixture
of research methods, both qualitative and quantitative, and
learn how and when to use each, as well as learning about their
strengths and limitations. Finally, build relationships with credible “cultural go-betweens” – people who have insights into how
to translate policies and programs into the local context.
Rolf Klemm, Vice President of Nutrition,
Helen Keller International
Rolf Klemm has more than 25 years of professional experience in international public health nutrition with expertise
that spans nutrition efficacy and effectiveness research and
program design, management and evaluation. He served as a
Peace Corps Volunteer (Philippines, 1979–81), Indochinese
Refugee Program Supervisor (1982–84), Program Manager and
Country Director for Helen Keller International (Philippines,
1986–98), Senior Technical Advisor and Technical Director of
USAID’s flagship A2Z micronutrient program (2009–11), and
Hopkins faculty member and principal and/or co-investigator
“There’s no substitute for the field”
(1998–present) for studies in Asia (Nepal, Pakistan, Bangladesh, Philippines) and sub-Saharan Africa (DRC, Kenya,
Tanzania, Malawi and Zambia). He currently serves as Vice
S&L: Do you have a final message for our readers, Rolf?
President for Nutrition with Helen Keller International and
holds a faculty appointment as Senior Associate at Johns
RK: There’s an enormous need for forums such as Sight and Life
magazine to showcase implementation science, elevate its status, and attract bright minds and compassionate hearts to this
area of inquiry. Because implementation science examines how
public health research findings are operationalized in practice or
in real-world settings, it is often perceived as a less prestigious
scientific field. But without effectively translating and delivering
evidence-based solutions, the power of research findings to improve and transform public health will remain unrealized.
S&L: Rolf, thank you for sharing your thoughts with us.
RK: Thank you. It’s been a pleasure.
Rolf Klemm was interviewed by Jonathan Steffen
Hopkins Bloomberg School of Public Health.
Source: www.hki.org